IBD Interferes With Sleep Quality

DENVER — People living with inflammatory bowel disease (IBD) not only had problems sleeping because of abdominal pain, but the sleep problems also made them more fatigued, more stressed, and more anxious, a researcher reported here.

In a study of 25 IBD patients, sleep instruments of the Patient-Reported Outcomes Measurement Information System (PROMIS) showed that sleeping problems significantly correlated with gastrointestinal and extraintestinal symptoms, according to Samantha Winders, PhD, a postdoctoral fellow at the University of Washington School of Nursing in Seattle.

“Recently, there has been a growing recognition of the bidirectional link between sleep and inflammation,” Winders stated during her poster session at the Crohn’s & Colitis Congress here. “Several studies have reported the prevalence of sleep disturbances in those with inflammatory bowel disease and found poor sleep has the potential to increase the risk of disease relapse.”

In the study, the PROMIS sleep disturbance instrument showed significant correlations with:

• Abdominal pain (Pearson’s r=0.56, P<0.01)
• Bloating (r=0.43, P<0.05)
• Constipation (r=0.46, P<0.05)
• Fatigue (r=0.50, P<0.05)
• Stress (r=0.42, P<0.05)

While the PROMIS sleep-related impairment instrument found correlations with:

• Bloating (r=0.47, P<0.05)
• Constipation (r=0.50, P<0.05)
• Fatigue (r=0.60, P<0.05)
• Depression (r=0.42, P<0.05)
• Stress (r=0.46, P<0.05)

The study also measured sleep quality and quantity using wrist actigraphy devices, and found that onset of sleep latency was significantly correlated with anxiety (r=0.41, P<0.05) and stress (r=0.42, P<0.05), while sleep time was significantly correlated with fatigue (r=0.42, P<0.05).

“While previous research has indicated potential associations between sleep and symptoms commonly reported in inflammatory bowel disease, few studies use objective measures of sleep,” she said. “Wrist actigraphy can objectively and noninvasively measure sleep-wake cycles and has been found feasible for use in the inflammatory bowel disease population.”

The study included 18 patients who had been diagnosed with Crohn’s disease and seven with ulcerative colitis. Overall, two-thirds were women, and participants had an average age of 32.5 years. Endoscopic assessment found active disease among nine of the patients while disease was inactive in 16 of the patients. The mean time since diagnosis of IBD was about 11 years.

Patients filled out multiple sleep questionnaires as well as the PROMIS surveys. Participants kept a 28-day symptoms diary, recording gastrointestinal-related symptoms such as abdominal pain, diarrhea, bloating, constipation, and fatigue, as well as stress, anxiety, and depression. Objective sleep data were obtained via wrist actigraphy for up to 15 days.

“Future work is needed to explore these relationships and the potential benefit of sleep interventions in this population,” Winders said.

“Sleep hygiene is something that is not efficiently addressed, I believe, in healthcare in general,” noted Syed Adeel Hassan, MD, of the University of Kentucky in Lexington, who was not involved with the study. “But one of the factors that is involved in the pathogenesis of inflammatory bowel disease is the gut microbiome.”

“Recent studies have shown that changes in sleep patterns or not having a healthy sleep hygiene affects your circadian rhythm, and circadian rhythm is one of the factors that influences your profile of the gut microbiome,” he told MedPage Today.

“There needs to be further studies of how sleep might be having an effect on gut microbiome and might predispose someone to have gut disturbances,” Hassan added. “Having a way to identify these influences on sleep would be promising. This is a way to getting to treat the whole person and not just the disease symptoms.”